HomeMy WebLinkAboutDisposition Forms_08-17_01/11/2017_Fire RECORDS DISPOSITION DOCUMENT NO.
Revised : 8/3/16 PAGE ( OF C PAGE(S)
1. AGENCY 2. DEPARTMENT Clerk 3. BUREAU
Village of Tequesta , A N/A
4. ADDRESS (Street, City, and Zip Code) 5. CONTACT (Name and Telephone Number)
345 Tequesta Drive Lori McWilliams, MMC
Tequesta, FL 33469 561- 768 -0440
6. SUBMITTED BY: I hereby certify that the records to be disposed of are 7. NOTICE OF INTENTION
correctly represented below, that any audit requirements for the records have
been fully justified, and that further retention is not required for any litigation The scheduled records listed in Item 8 are to be disposed of in the
pending or imminent. To be signed by department head only. manner checked below (specify only one):
Si nature Date a. Shred 0 b. Recycle
c. Imaging and Destruction 0 d. Removed from Server
Name an itle e. Other
6. LIST OF RECORD SERIES
Fa. b. C. d. e. f. g.
ceue Item Title Retention Inclusive Volume Disposition
Item No. Dates in Action and Date
Cubic Completed After
Feet Authorization
R u n-e
--� . o
II I Lull
� \
U
Gs - e� � t - •�
t
�- bx5 TOTAL CUBIC FEET:
9. DISPOSAL AUTHORIZATION: Disposal for the above listed records 10. DISPOSAL CERTIFICATE The above listed records have been
authorized. Any deletions or modifications are indicated disposed of in the manner and on the date shown in column g.
(Witness to the Records Disposition)
Signature: f h Wt/, Date: A� Signature.
U i A Date:
J i.
Print Name: Lori McWilliams Print Name:
Print Title: Village Clerk Print Title:
NOTE: Upon disposition retain this form for your records
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